The Humble Sentence
Nurse Author & Editor, 2019, 29(4), 5
As we learned in nursing school, proteins are made up of chains of amino acids joined end to end. Now let’s apply that to writing: amino acids = words, chains of amino acids = sentences, joined chains = paragraphs, and protein = finished product, whether it’s a book, an article, or even a letter to the editor. Much attention is paid to the joining of paragraphs (manuscript organization), but I think the real power of writing lies in the amino acids (words) and amino acid chains (sentences). These building blocks are essential (think of essential amino acids) to create a powerful impression on the reader, yet they seem to garner far less attention in publications about writing.
The sentence labors in obscurity, guiding the reader to greater understanding, but rarely getting the attention it deserves. But by recognizing and celebrating the humble sentence, you can boost your ability to deliver an effective message.
Anatomy of a Sentence
I remember the writing professor who taught me that “Good writing consists of nouns and verbs.” He was describing the sentence in its most basic form—a noun (actor) as a subject and a verb (action). A simple example is: Nurses care. In most cases, an object is needed, so the basic sentence structure is subject, verb, object, as in: Nurses care for patients. In this case, “patients” is a direct object, or the receiver of the action.
The professor’s point was that the essentials need to be in place before sparingly applying adjectives or an occasional adverb, as in: Critical care nurses care for seriously ill patients.
These basics apply whether you’re writing for a newsletter or a research journal. Unfortunately, too many nurses labor under the belief that academic or “scholarly” writing is passive and convoluted. One of the hallmarks of academic writing is turning “spunky” verbs into “clunky” nouns that are incapable of doing a verb’s job. For example if you are stumbling over “Adrenal glands’ production of aldosterone…” try “Adrenal glands produce aldosterone…”, which converts production to produce and eliminates a problematic apostrophe.
Another hallmark of academic writing is the passive voice, where the classic order of subject, verb, object is changed to object, verb, subject. For example, “Education was provided by the nurse to the group of patients,” rather than “The nurse provided education…” or even better, “The nurse taught the group of patients.”
Clunky verbs and passive voice make it hard for readers to understand your message. Remember that the amount that readers absorb depends on two things: 1) how much effort it takes and 2) how much value they receive. If you tip readers too far on the effort side of the equation, by using clunky verbs and passive voice, they may stop reading, even if the value is high.
The Four Cs
To enhance the likelihood a reader will not have to work hard to find the value in the information you are providing, think of putting sentences together so your writing is clear, concise, correct, and compelling—the four Cs of writing. You can use several strategies to achieve the four Cs; each strategy typically addresses more than one “C”. For example, streamlining a sentence can make an article more concise and compelling.
Use passive voice sparingly. If you have difficulty determining if a sentence is in active or passive voice, check for forms of the verb “to be” (for example, is are, was, were, been, could be, should be, may be). Then look for object, verb, subject or object, and verb construction.
Passive: A neurologic assessment was performed by the nurse every 2 hours. The order is: object = neurological assessment, verb = was (a form of “to be”), subject = nurse.
Active: The nurse performed a neurologic assessment every 2 hours. Now the order is subject = nurse, verb = performed (note the elimination of “was”), object = neurologic assessment.
If you’re having difficulty converting a passive sentence to an active one, ask, “Who does what to whom?” (Redish, 2012). The person or thing doing the action goes before the verb.
A manuscript composed entirely of active voice sentences is no better than one with primarily passive voice. Passive voice is helpful when it’s more important what was done than who did it, as is the case with the methods section of a research manuscript. The repetition of “We randomized the sample…” “We administered the survey…” would soon grow tedious. However, “we” and “I” have a role most types of writing, which brings me to the next strategy.
Take ownership. You (and any co-authors you may have) are responsible for the content of the article. “Academic” writing often bans “I” and “we” (also known as first-person pronouns), but the four Cs of writing welcomes them. If you developed the curriculum say so; your writing will be the better for it, especially because your sentence will be active rather than passive.
For example, instead of “A new curriculum consisting of five modules was developed,” write “We developed a new curriculum of five modules.” The latter sentence makes it clear that the authors of the study created the modules, as opposed to someone else, and eliminates a few unnecessary words.
One caveat: Look at articles published in the journal you are considering as a publication outlet for your manuscript. If you do not see any first-person pronouns in the articles, then you probably don’t want to include them in your manuscript, even if the more direct voice would sound better. In this case, it’s more important to follow the journal’s style.
Ownership also means not being afraid to take a stand. Avoid words and phrases such as apparently, it appears, or to a degree. State what you believe and back it up as needed.
Before: It would appear that nurses are worried about their safety at work.
After: Based on our results, nurses are increasingly concerned about their safety at work. Or, to avoid the “our” (because of journal style): Based on these results…
Streamline the sentence. One of the easiest tricks to writing a more effective sentence is to tidy it up in the same way you tidy a room—by removing clutter. For example:
Before: It is important to remember that bystanders may confuse a seizure with behavioral problems or the inappropriate use of drugs.
After: Bystanders and first responders may confuse seizures with behavior problems or illicit drug use.
You must be ruthless when cutting words. Look for vague words and repetition. If you’re unsure if you have hit the mark, try reading both sentences out loud. Of these two, which sentence sounds better?
Hepatitis B is spread in the bloodstream, which is different from how hepatitis A is transmitted, which is via the fecal-oral route.
Unlike the bloodborne pathogen spread of hepatitis B, hepatitis A is transmitted via the fecal-oral route.
You likely chose the second, cleaner sentence. Note the repetitive words that were eliminated.
Here are examples of what to look for when streamlining a sentence:
- Extraneous words. Every word needs to pull its weight by contributing to the sentence. Pay particular attention to adverbs; for example, in nearly all cases, “very” can be eliminated. “That” is another word that can often be cut:
- “Most (55%) of the nurses reported that they experienced moral distress in the past 30 days” would work better as “Most (55%) nurses reported…”
Here are some examples of extraneous words and their substitutes:
|Unnecessary words||More concise|
|A majority of||Most|
|Due to the fact that||Because|
|Have an effect on||Affect|
|A large number of||Many|
- Lazy phrases. Is the phrase working or simply taking up space? For example, “It should be emphasized,” “there are,” and “there is” are all weak.
- “There are five steps to the model” would work better as “The model has five steps.”
- “The data confirm that there is an association between cognitive decline and poor diet” would work better as “The data confirm an association between cognitive decline and poor diet.”
- Long words or phrases. Try to shorten these. For example, “a majority of” = “most,” “all four of the” = “all,” “based on the assumption of” = “if.”
- Unnecessary jargon and abbreviations. Not all readers will be experts in your specialty, so choose your words carefully and define abbreviations. For example, CRF could refer to case report form, chronic renal failure, or chronic respiratory failure. Pinker (2014), author of Sense of Style, writes, “The better you know something, the less you remember how hard it was to learn.” He refers this as the “curse of knowledge.”
- Negatives. In addition to taking up space, negatives easily can be misinterpreted. Try to recast the sentence or substitute a different word. For example, instead of “Nurses did not believe the intervention was harmful,” try “Nurses believed the intervention was helpful.” When a negative is called for, be precise and concise. For example, consider changing “did not succeed” to “failed” and “did not remember” to “forgot.”
- Pizza pies. Another example of extraneous words or lazy phrases, “pizza pies” (Nicoll, 2015) are modifiers that become unnecessary after first mention. For example if your study participants were “junior level pre-licensure baccalaureate nursing students” you can simply call them “the students” or “the participants” once you have established who they are and why they were in the sample. There is no need to repeat the six-word description throughout the text.
As author William Zinsser (1976/2006) wrote,
[T]he secret of good writing is to strip every sentence to its cleanest components. Every word that serves no function, every long word that could be a short word, every adverb that carries the same meaning that’s already in the verb, every passive construction that leaves the reader unsure of who is doing what—these are the thousand and one adulterants that weaken the strength of a sentence. And they usually occur in proportion to education and rank.
Check connections. Use transitions within sentences and to tie your sentences together. For example:
- First, explain the procedure to the patient, next…
- The primary goal of the project is…the secondary goals are…
Here are some examples of types of transitions and words that can help convey them.
|Sequence||First, second, third|
|Show, example||For example, for instance|
|Conclude (cause and effect)||As a result, consequently, finally|
|Contrast||In contrast, rather, on the other hand, however|
|Compare||By comparison, compared to|
|Time||Meanwhile, then, after, later, subsequently|
|Addition||Furthermore, moreover, in addition|
|Concession||Nevertheless, however, of course, although|
Conjunctions (if, and, but, yet, so) connect words, phrases (do not have a subject and verb), and sentences (have a subject and verb). For example, “Leaders completed simulation training, and they conducted at least two simulations under the guidance of an experienced instructor.”
Make punctuation work for you. A period is usually the best way to end a sentence (hold those exclamation points for social media), but what about punctuation within the sentence? You can use commas, colons, dashes, parentheses, and semicolons to link parts of a sentence, emphasize key elements, and make a longer sentence easier to understand. The last point is worth exploring more. Shorter sentences are better than longer ones, but an article of all short sentences would end up reading like a children’s book. When someone notes that a sentence is “too long,” consider if it should be broken into two or if it needs punctuation to make it more readable.
Sometimes combining sentences can make your point stronger. Goldsmith (2017) provides this example:
Before: The shigella bacteria may take 2 to 4 days to incubate. It is transmitted though interpersonal contact. The infection is highly contagious, and patients may show signs of bloody diarrhea, fever, vomiting, and abdominal cramps.
After: Easily passed from person to person, the shigella bacteria can incubate in 2 to 4 days before showing symptoms of bloody diarrhea, fever, vomiting, and abdominal cramps.
You are probably most familiar with using commas to separate items in a list, but they also can be used to connect two short sentences or at the end of an introductory phrase as in, “Although patients identified their objectives before the support group started, many refined their goals midway through the intervention.”
Parentheses are helpful for giving readers additional information (words, phrases, or sentences) that’s helpful, but of less importance than the main sentence. Removing what is in parentheses should not change the meaning of a sentence, as in: “We determined glycemia (based on hemoglobin A1C) before enrolling the patients into the study.”
Semicolons connect two independent clauses; a clause consists of a noun and verb. Semicolons also are used when items in a list already contain commas, such as:
“…created a detailed, two-page algorithm; provided education sessions; and followed up to determine effectiveness.”
A colon tells the reader, “Pay attention to what comes next.” A colon may introduce the reader to a bulleted list, or, more often, it expands on the thought just expressed.
Some editors have a strong anti-dash bias, but like a potent spice, dashes can be effective if used sparingly. Like colons, dashes call attention to themselves, for example, in the sentence “Helping patients establish their own goals—preferably ones that are measurable—will improve the likelihood of success,” the dashes help emphasize the importance of having goals that can be measured.
Order for strength. The strongest parts of a sentence are the beginning and the end, so don’t bury the most important information in the middle. Consider this sentence:
“Peripheral vascular access device complications, including tissue injury, infection, emboli, and extravasations, can lead to increased morbidity and mortality.”
The actual complications are certainly important, but in this case, the most important point is that those complications cause illness and death.
Make Your Sentences Proud
Sentences are a powerful tool for delivering an effective message. Pay attention to this humble tool and you’ll find your writing skills will grow exponentially.
- Goldsmith, J.A. (2017). Writing effectively. In C. Saver, (ed). Anatomy of Writing for Publication for Nurses, (3rd Ed). pp. 111-126. Sigma Theta Tau.
- Nicoll, L. H. (2015). Becoming a ruthless editor. Nurse Author & Editor, 25(2), 2. Retrieved from http://naepub.com/writing-basics/2015-25-2-2/
- Pinker, S. (2014). The Sense of Style. Penguin Books.
- Redish, J. (2012). Letting Go of the Words: Writing Web Content That Matters, (2nd ed). Morgan Kaufmann, an imprint of Elsevier.
- Zinsser, W. (1976/2006). On Writing Well: The Classic Guide to Writing Non-Fiction. 30th Anniversary Edition. HarperCollins.
About the Author
Cynthia Saver, MS, RN, is president of CLS Development, Inc., which provides writing and editorial management services to leading nursing publishers. She is editor of Anatomy of Writing for Publication for Nurses, 3rd ed., is a member of the Nurse Author & Editor Authors-in-Residence, and presents writing workshops for nurses.
Copyright 2019: The Author. May not be reproduced without permission.
Journal Complication Copyright 2019: John Wiley and Son Ltd.